- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Austin, TX)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Evolent (Austin, TX)
- …Job Description As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not...are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes… more
- Toshiba International Corporation (Houston, TX)
- …methods, and quality control standards. + Analyzes and plans work force utilization , space requirements, and workflow, and designs layout of equipment and workspace ... quality control standards. + Analyzes and plans work force utilization , space requirements, and workflow, and designs layout of...with R&D or design groups to go over design review process in new product development. + Will utilize… more
- Highmark Health (Austin, TX)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- AECOM (Dallas, TX)
- …to I&G Director for annual budgets and business planning, staff utilization , department resource needs (hardware/software needs, strategic investments) and other ... future resource and staff needs to optimize the department staff utilization , including incorporation of value Engineering Centers in project staff planning… more
- Royal Vopak (Deer Park, TX)
- …is a big plus + Good knowledge and experience of cost estimating software utilization + Good knowledge and experience of CAD software utilization + Expert ... project owner identifying project technical staffing requirements to support projects + Review and validate Project Management plans + Initiate and organize key… more
- Highmark Health (Austin, TX)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Houston Methodist (Houston, TX)
- …patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... benefits for patients and reimbursement for the hospital. + Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource … more